Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care Units

作者：Christopher P. Landrigan, Jeffrey M. Rothschild, JOHN W. CRONIN, Rainu Kaushal, Elisabeth Burdick, Joel T. Katz, Craig M. Lilly, Peter Howard Stone, Steven W. Lockley, David Westfall Bates, Charles Andrew Czeisler · 发表于：New England Journal of Medicine · 年份：2004 · DOI：10.1056/nejmoa041406 · 被引用次数：1768 · 研究领域：Sleep and Work-Related Fatigue、Patient Safety and Medication Errors、Hospital Admissions and Outcomes

BACKGROUND: Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors. METHODS: We conducted a prospective, randomized study comparing the rates of serious medical errors made by interns while they were working according to a traditional schedule with extended (24 hours or more) work shifts every other shift (an "every third night" call schedule) and while they were working according to an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week. Incidents were identified by means of a multidisciplinary, four-pronged approach that included direct, continuous observation. Two physicians who were unaware of the interns' schedule assignments independently rated each incident. RESULTS: During a total of 2203 patient-days involving 634 admissions, interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001), including 56.6 percent more nonintercepted serious errors (P<0.001). The total rate of serious errors on the critical care units was 22.0 percent higher during the traditional schedule than during the intervention schedule (193.2 vs. 158.4 per 1000 patient-days, P<0.001). Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03...